Yesterday our Emergency Department Healthcare team of 4 RN's, an ED Tech and the doctor who heads up the ED met for the first time to attempt to positively impact the Door to Doc time. You will remember that this is the elapsed time from when the patient enters the ED until the exam begins with the physician. We first discussed the project charter to make certain that everyone understood the scope and objective as well as the metrics selected for this improvement initiative. The team then received some "just in time" training on Lean, Six Sigma and Constraints Management to prepare them for the work to be done this week. The metrics of choice and the current status for each were as follows:
1. Overall Patient Satisfaction - 84%
2. Patient Satisfaction for Waiting Time to See the Doctor - 70.4%
3. Door to Doctor Cycle Time - Average of 88 minutes
The team then went on a Gemba Walk in the Emergency Department to collect important information so that we could construct a high level map of the current Door to Doc process. The team followed several patients to determine if the cycle time of 88 minutes still holds true and based upon the team following five patients, it appears as though it does.
The team then constructed a high level process map which included estimated processing times for each step in this process. Figure 1 below is a visual of the Door to Doc process.
In Figure 1 we see the patient arriving at the Emergency Department and then goes through a registration step and a brief triage by the nurse and then entry of the information into a computer database. This step takes roughly 2 minutes to complete. The patient is then placed into a waiting room and stays there for roughly 15 minutes until a second triage occurs which takes approximately 5-10 minutes. Once again the patient returns to the waiting room for about 30 minutes on average until an ER Room bed becomes available. The patient typically stays in the ER Room for 45 minutes until they are finally seen by a doctor.
The next order of business was to identify the system constraint and it became quite clear that the time spent in the ER Room, at 45 minutes, was the system constraint. This actually translates into time spent waiting for the doctor to come evaluate them. As you can see, most of the time in this process is waiting time, so that's where the team will focus it's efforts on ways to reduce this wait time.
Today we will be constructing a current state process map and hopefully complete a value stream analysis of this process.